Landmark accuracy in spinal anaesthesia in obese obstetric patients V1
Research type
Research Study
Full title
Assessing the accuracy of the landmark technique for insertion of spinal anaesthesia in the obese obstetric population undergoing planned caesarean section. Should lumbar ultrasound be used routinely?
IRAS ID
213618
Contact name
Fleur Roberts
Contact email
Sponsor organisation
Sheffield Teaching Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 11 months, 28 days
Research summary
Caesarean section is a common operation usually performed under spinal anaesthesia. This involves an injection of numbing local anaesthetic into the lower back around the nerves at the bottom of the spinal cord. It is routinely performed by feeling the bones of the hips and back to estimate how high up the spine to inject. It is important the injection is not too high as this risks damaging the spinal cord and potentially causing pain and paralysis.
This traditional technique of feeling the bones has been shown to be inaccurate in all patients but has a low rate of serious complications. Ultrasound scanning is a different proven but not widely used technique to identify how high up the spine to inject. It may be especially useful where feeling the bones is difficult and there is a higher risk of inaccuracy in determining how high up the spine to inject. This may reduce the risk of an inadvertently high level of spinal injection and rare but serious complications such as nerve damage and paralysis.
No study has specifically looked prospectively at obesity in the pregnant population as a risk factor for inaccuracy in the level of injection. We wish to compare the estimated level of injection derived by feeling the bones with the actual level confirmed using ultrasound. We plan to look at 50 obese patients , with a body mass index greater than 35, and 50 patients with a body mass index of less than 35 who are undergoing planned caesarean section with spinal anaesthesia to see if obesity is a risk factor for inaccuracy. This could ultimately lead to a recommendation for routine ultrasound use in this group, a reduced risk of serious complications such as paralysis and improved patient experience.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
16/NE/0410
Date of REC Opinion
16 Dec 2016
REC opinion
Favourable Opinion